息肉状脉络膜血管病变(PCV)好发于中老年人群,主要临床特征为脉络膜内异常血管形态,如分支状脉络膜血管网和血管末端息肉样扩张,视网膜下橘红色结节样病变及出血性或浆液性视网膜色素上皮脱离(PED),易造成视网膜出血或玻璃体积血,是主要致盲眼底病变之一。抗血管内皮生长因子(VEGF)药物玻璃体内注射是目前PCV治疗的主要方法,在消除异常血管网和清除息肉样病灶、减轻血管渗出及促进渗出液吸收、改善视力预后方面具有一定的优势,但频繁的玻璃体内药物注射增加了感染的风险,也增加患者的治疗负担。此外,治疗后的高复发率也给临床实践带来了巨大挑战,因此寻求药效持久且经济负担较轻的新型治疗药物是PCV临床研究关注的焦点。brolucizumab是一种新型小分子抗VEGF类人源化单抗药物,具有组织穿透性强、局部药物浓度及生物利用度高、注射剂量小、药效持久和注射间隔时间长等优势,为PCV的临床治疗及患眼预后改善带来了新的希望。目前虽然有较多文献证实了brolucizumab治疗PCV的疗效和安全性,但文献多来自于日本、印度和韩国,仍然缺乏中国的临床实践数据。随着该药物在多个国家的批准上市,相信在不久的将来该治疗方法可惠及更多的PCV患者。我国的眼科医师和研究者应密切关注brolucizumab在PCV治疗中的研究进展。
Polypoidal choroidal vasculopathy (PCV) occurs in the middle-aged and elderly population and is characterized by abnormal intrachoroidal vascular patterns such as branching choroidal vascular networks and polypoidal dilatation of vessel terminals, subretinal orange nodular lesions and hemorrhagic or plasma retinal pigment epithelial detachment (PED), which can cause retinal hemorrhage or vitreous hematopoiesis and is one of the major blinding fundus lesions.Intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs is currently the main method of PCV treatment, and has certain advantages in eliminating abnormal vascular networks and removing polypoidal lesions, reducing vascular exudation and promoting exudate absorption, and improving visual prognosis.However, frequent intravitreal drug injections increase the risk of infection and the treatment burden for patients.In addition, the high recurrence rate after treatment poses a significant challenge to clinical practice, so the search for new therapeutic agents that are durable and less costly is a focus of clinical research in PCV.The literature from abroad suggests that brolucizumab is a novel small-molecule anti-VEGF humanized monoclonal antibody with the advantages of high tissue penetration, high local drug concentration and bioavailability, small injectable dose, long-lasting efficacy and long injection interval, which brings new hope for the clinical treatment of PCV and improving the prognosis of affected eyes.Although the efficacy and safety of brolucizumab in the treatment of PCV have been well documented, the literature is mainly from Japan, India and Korea, and clinical practice data from China are still lacking.With the approval of the drug in several countries, it is believed that more PCV patients could benefit from this treatment in the near future.Ophthalmologists and researchers in China should closely follow the progress of brolucizumab in the treatment of PCV.
刘璟瑶,刘勃实,李筱荣. 关注brolucizumab对息肉状脉络膜血管病变的治疗作用及其临床应用[J]. 中华实验眼科杂志,2023,41(07):617-622.
DOI:10.3760/cma.j.cn115989-20230315-00087版权归中华医学会所有。
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